scholarly journals A Doppler ultrasound self-monitoring approach for detection of relevant individual decompression stress in scuba diving

2021 ◽  
Author(s):  
Andreas Fichtner ◽  
Benedikt P. Brunner ◽  
Thomas Pohl ◽  
Thomas Grab ◽  
Tobias Fieback ◽  
...  
Keyword(s):  
Medical Professional ◽  
Detection Sensitivity ◽  
Site Conditions ◽  
Self Assessment ◽  
Significant Information ◽  
Bubble Detection ◽  
2D Echocardiography ◽  
Average Maximum ◽  
Decompression Stress ◽  
Diving Safety

AbstractObserving modern decompression protocols alone cannot fully prevent diving injuries especially in repetitive diving. Professional audio Doppler bubble measurements are not available to sports scuba divers. If those non-professionals were able to learn audio Doppler self-assessment for bubble grading, such skill could provide significant information on individual decisions with respect to diving safety. We taught audio Doppler self-assessment of subclavian and precordial probe position to 41 divers in a 45-min standardized, didactically optimized training. Assessment before and after air dives within sports diving limits was made through 684 audio Doppler measurements in dive-site conditions by both trained divers and a medical professional, plus additional 2D-echocardiography reference. In all dives (average maximum depth 22 m; dive time 44 min), 33% of all echocardiography measurements revealed bubbles. The specificity of audio bubble detection in combination of both detection sites was 95%, and sensitivity over all grades was 40%, increasing with higher bubble grades. Dive-site audio-Doppler-grading underestimated echo-derived bubble grades. Bubble detection sensitivity of audio Doppler self-assessments, compared to an experienced examiner, was 62% at subclavian and 73% at precordial position. 6 months after the training and 4.5 months after the last measurement, the achieved Doppler skill level remained stable. Audio Doppler self-assessment can be learned by non-professionals in a single teaching intervention. Despite accurate bubble grading is impossible in dive-site conditions, relevant high bubble grades can be detected by non-professionals. This qualitative information can be important in self-evaluating decompression stress and assessing measures for increased diving safety.

scholarly journals Teaching Self-Assessment of Doppler Ultrasound for Bubble Grading in Divers: Learning Curve, Reliability, and Surveying Precision.

2020 ◽  
Author(s):  
Andreas Fichtner ◽  
Anne Münch ◽  
Denise Preuss ◽  
Thomas Pohl ◽  
Thomas Grab ◽  
...  
Keyword(s):  
Learning Curve ◽  
Training Session ◽  
Medical Professional ◽  
Self Assessment ◽  
Scuba Divers ◽  
Diving Accidents ◽  
2D Echocardiography ◽  
Qualitative Finding ◽  
Professional Assessment ◽  
Venous Signal

Abstract BackgroundObserving modern decompression protocols alone cannot fully prevent Diving Accidents especially in repetitive diving. Audio Doppler bubble measurements to estimate supersaturation are done in special professional settings only, being not available for the broad community of sports SCUBA divers. In case SCUBA divers without medical and ultrasound training could learn audio Doppler self-assessment for reliable bubble grading on a stable skill level and with an efficient single teaching intervention, this skill could add significantly to diving safety. MethodsWe taught audio Doppler self-assessment of the subclavian vein and cardiac precordial probe position to 41 divers in a 45-minute standardized training session. Assessment was made of 684 audio Doppler measurements by both the trained divers and a medical professional plus additional 2D-echocardiography as reference. ResultsAll air dives were within normal sports diving limits and decompression bubbles were observable via echocardiography in 32.3% of all measurements. The specificity of audio bubble detection was 96.1% but the sensitivity was low for lower bubble grades, increasing to 25%, 35% and 67% for higher echo-detected bubble grades 3, 4 and 5. The number of attempts to achieve a reliable venous signal within 30 seconds was 13 at the subclavian position and 18 at the precordial position. More bubble positive measurements could be detected at the precordial position for both self and medical professional assessment. The performance level of the taught skill remained stable over six months without further practice.ConclusionAudio Doppler self-assessment can be learned by people without medical and ultrasound training and a reliable venous signal can be achieved after a comparably steep learning curve. However, accurate bubble grading is not possible using audio Doppler as only higher bubble grades can be detected. Nevertheless, this qualitative finding can be important in self-evaluating decompression stress and potentially help the diver to judge on measures for avoiding decompression accidents.

scholarly journals Teaching Self-Assessment of Doppler Ultrasound for Bubble Grading in Divers: Learning Curve, Reliability, and Surveying Precision.

2020 ◽  
Author(s):  
Andreas Fichtner ◽  
Anne Münch ◽  
Denise Preuss ◽  
Thomas Pohl ◽  
Thomas Grab ◽  
...  
Keyword(s):  
Learning Curve ◽  
Training Session ◽  
Medical Professional ◽  
Teaching Intervention ◽  
Self Assessment ◽  
Scuba Divers ◽  
2D Echocardiography ◽  
Qualitative Finding ◽  
Professional Assessment ◽  
Venous Signal

Abstract BackgroundAudio Doppler bubble measurements of SCUBA divers are done in special professional settings to estimate supersaturation and avoid decompression accidents. However, it is unknown whether sports SCUBA divers without medical and ultrasound training can learn audio Doppler self-assessment for reliable bubble grading with a single teaching intervention. Further, it is unknown whether they are able to establish a stable practical skill level after that teaching intervention in order to allow appropriate judgment on decompression stress.MethodsWe taught audio Doppler self-assessment of the subclavian vein and cardiac precordial probe position to 41 divers in a 45-minute standardized training session. Assessment was made of 684 audio Doppler measurements by both the trained divers and a medical professional plus additional 2D-echocardiography as reference. ResultsAll air dives were within normal sports diving limits and decompression bubbles were observable via echocardiography in 32.3% of all measurements. The specificity of audio bubble detection was 96.1% but the sensitivity was low for lower bubble grades, increasing to 25%, 35% and 67% for higher echo-detected bubble grades 3, 4 and 5. The number of attempts to achieve a reliable venous signal within 30 seconds was 13 at the subclavian position and 18 at the precordial position. More bubble positive measurements could be detected at the precordial position for both self and medical professional assessment. The performance level of the taught skill remained stable over six months without further practice.ConclusionAudio Doppler self-assessment can be learned by people without medical and ultrasound training and a reliable venous signal can be achieved after a comparably steep learning curve. However, accurate bubble grading is not possible using audio Doppler as only higher bubble grades can be detected. However, this qualitative finding can be important in self-evaluating decompression stress and potentially help the diver to judge on measures for avoiding decompression accidents.

scholarly journals Self-Assessment of Medical Interns on Their Ability to Management of Inpatients in the Internal Department at Shahid Sadoughi University of Medical Sciences

2021 ◽  
Author(s):  
M Mirzadeh ◽  
H Soleymani-Salehabadi ◽  
M Akhondi-Meybodi
Keyword(s):  
Clinical Skills ◽  
Medical Professional ◽  
Validity And Reliability ◽  
Self Assessment ◽  
Chi Square ◽  
Cross Sectional ◽  
Patient Decision Making ◽  
Patient Decision ◽  
Chi Square Test ◽  
Medical Interns

Introduction: Knowledge of medical students is usually assessed by exams, but it is not related to their sense of readiness. Self-assessment is one of the methods for measuring medical professional readiness that has been less considered in medical education. This study aimed to determine the degree of acquisition of professional skills of medical interns in the management of inpatients through self-assessment in the internal ward. Methods: In this cross-sectional descriptive study, 115 selected medical interns of Shahid Sadoughi Medical School in Yazd participated by census in 2017. Ability to manage internal diseases was assessed by self-reported. The internist experts confirmed questionnaire validity and reliability (Cronbach's alpha: 0.76-0.93). Data were analyzed using descriptive statistics and chi-square test by SPSS. Result: The highest expressed ability by interns was for management of gastrointestinal (63.9%), respiratory (62.3%), and cardiovascular disease (56.1%). They had the lowest ability for endocrine diseases (49.8%). The highest ability to manage gastrointestinal bleeding (65.8%), chest pain (64.3%), abdominal pain and reflux (62.5%), nausea/vomiting (61.6%), and diabetes (61.4%) was stated. 94.7% have sufficient skills to take a history and 85.6% follow medical ethics. The least expressed ability was in drug prescribing and patient decision-making. Conclusion: In 23% of common diseases, 50% of interns can manage disorders independently, which indicates that interns do not consider themselves capable of managing them. The professors must consider Self-assessment and evaluation in prioritizing internship training topics, especially clinical skills.

Differential diagnostic value of tongue examination in acute and chronic pathology

1986 ◽  
Vol 67 (2) ◽  
pp. 147-151
Author(s):  
V. F. Bogoyavlensky ◽  
I. F. Bogoyavlensky
Keyword(s):  
Oral Cavity ◽  
Lymph Nodes ◽  
Soft Palate ◽  
Daily Practice ◽  
Detailed Examination ◽  
Diagnostic Value ◽  
Medical Professional ◽  
Dental Development ◽  
Significant Information ◽  
Periodontal Condition

In daily practice, any medical professional always examines the tongue, but it is difficult to obtain diagnostically significant information without a thorough, simultaneous examination of the oral cavity. In this regard, it is necessary to recall the generally accepted scheme of detailed examination of the oral cavity: lips, teeth and dentures are examined, including anomalies of dental development, caries, periodontal condition; gums; transitional fold; cheek mucosa; condition of hard and soft palate; tongue, sublingual area; pharynx. Lymph nodes are palpated - submandibular, deep cervical, parotid, occipital. The condition of salivary glands is examined.

Practical Realization of a Reference System for Earth Dynamics by Satellite Methods

1975 ◽  
Vol 26 ◽  
pp. 341-380 ◽  
Author(s):  
R. J. Anderle ◽  
M. C. Tanenbaum
Keyword(s):  
Reference Frame ◽  
Polar Motion ◽  
Pole Position ◽  
Control Points ◽  
Significant Information ◽  
Crustal Motion ◽  
Average Reference ◽  
Future Data ◽  
Existing Data

AbstractObservations of artificial earth satellites provide a means of establishing an.origin, orientation, scale and control points for a coordinate system. Neither existing data nor future data are likely to provide significant information on the .001 angle between the axis of angular momentum and axis of rotation. Existing data have provided data to about .01 accuracy on the pole position and to possibly a meter on the origin of the system and for control points. The longitude origin is essentially arbitrary. While these accuracies permit acquisition of useful data on tides and polar motion through dynamio analyses, they are inadequate for determination of crustal motion or significant improvement in polar motion. The limitations arise from gravity, drag and radiation forces on the satellites as well as from instrument errors. Improvements in laser equipment and the launch of the dense LAGEOS satellite in an orbit high enough to suppress significant gravity and drag errors will permit determination of crustal motion and more accurate, higher frequency, polar motion. However, the reference frame for the results is likely to be an average reference frame defined by the observing stations, resulting in significant corrections to be determined for effects of changes in station configuration and data losses.

Applications of SIMS to electronic materials and devices

1992 ◽  
Vol 50 (2) ◽  
pp. 1682-1683
Author(s):  
S.F. Corcoran
Keyword(s):  
Depth Distribution ◽  
Secondary Ion Mass Spectrometry ◽  
Semiconductor Device ◽  
Electronic Materials ◽  
Profile Analysis ◽  
Semiconductor Industry ◽  
Small Diameter ◽  
Depth Resolution ◽  
Detection Sensitivity

Over the past decade secondary ion mass spectrometry (SIMS) has played an increasingly important role in the characterization of electronic materials and devices. The ability of SIMS to provide part per million detection sensitivity for most elements while maintaining excellent depth resolution has made this technique indispensable in the semiconductor industry. Today SIMS is used extensively in the characterization of dopant profiles, thin film analysis, and trace analysis in bulk materials. The SIMS technique also lends itself to 2-D and 3-D imaging via either the use of stigmatic ion optics or small diameter primary beams.By far the most common application of SIMS is the determination of the depth distribution of dopants (B, As, P) intentionally introduced into semiconductor materials via ion implantation or epitaxial growth. Such measurements are critical since the dopant concentration and depth distribution can seriously affect the performance of a semiconductor device. In a typical depth profile analysis, keV ion sputtering is used to remove successive layers the sample.

Continuum of Care Following Sports-Related Concussion

2020 ◽  
Vol 29 (3) ◽  
pp. 1389-1403
Author(s):  
Jessica Brown ◽  
Kelly Knollman-Porter
Keyword(s):  
Young Adults ◽  
Life Span ◽  
Sports Injuries ◽  
Continuum Of Care ◽  
Medical Professional ◽  
Structured Interviews ◽  
Youth Athletes ◽  
Speech Language Pathologist ◽  
History Of ◽  
Injury Reporting

Purpose Although guidelines have changed regarding federally mandated concussion practices since their inception, little is known regarding the implementation of such guidelines and the resultant continuum of care for youth athletes participating in recreational or organized sports who incur concussions. Furthermore, data regarding the role of speech-language pathologists in the historic postconcussion care are lacking. Therefore, the purpose of this retrospective study was to investigate the experiences of young adults with history of sports-related concussion as it related to injury reporting and received follow-up care. Method Participants included 13 young adults with history of at least one sports-related concussion across their life span. We implemented a mixed-methods design to collect both quantitative and qualitative information through structured interviews. Participants reported experiencing 42 concussions across the life span—26 subsequent to sports injuries. Results Twenty-three concussions were reported to a parent or medical professional, 14 resulted in a formal diagnosis, and participants received initial medical care for only 10 of the incidents and treatment or services on only two occasions. Participants reported concussions to an athletic trainer least frequently and to parents most frequently. Participants commented that previous experience with concussion reduced the need for seeking treatment or that they were unaware treatments or supports existed postconcussion. Only one concussion incident resulted in the care from a speech-language pathologist. Conclusion The results of the study reported herein shed light on the fidelity of sports-related concussion care management across time. Subsequently, we suggest guidelines related to continuum of care from injury to individualized therapy.

Outcomes: Promoting Reflective Practice Using Performance Indicator Questionnaires

2010 ◽  
Vol 20 (2) ◽  
pp. 64-70 ◽  
Author(s):  
Mary Pat McCarthy
Keyword(s):  
Clinical Education ◽  
Performance Indicator ◽  
Clinical Skills ◽  
Self Assessment ◽  
Clinical Practicum ◽  
Self Reflection ◽  
Healthcare Settings ◽  
Language Pathology ◽  
Traditional Performance ◽  
The University

This article details the process of self-reflection applied to the use of traditional performance indicator questionnaires. The study followed eight speech-language pathology graduate students enrolled in clinical practicum in the university, school, and healthcare settings over a period of two semesters. Results indicated when reflection was focused on students' own clinical skills, modifications to practice were implemented. Results further concluded self-assessment using performance indicators paired with written reflections can be a viable form of instruction in clinical education.

Students Involvement in Multilingual and Multicultural Community Services

2015 ◽  
Vol 22 (2) ◽  
pp. 77-89 ◽  
Author(s):  
Ying-Chiao Tsao
Keyword(s):  
Service Learning ◽  
Cultural Competence ◽  
Linguistically Diverse ◽  
Community Services ◽  
Cultural Humility ◽  
Self Assessment ◽  
Multicultural Community ◽  
Raising Awareness ◽  
Hands On ◽  
Teaching Learning

Promoting cultural competence in serving diverse clients has become critically important across disciplines. Yet, progress has been limited in raising awareness and sensitivity. Tervalon and Murray-Garcia (1998) believed that cultural competence can only be truly achieved through critical self-assessment, recognition of limits, and ongoing acquisition of knowledge (known as “cultural humility”). Teaching cultural humility, and the value associated with it remains a challenging task for many educators. Challenges inherent in such instruction stem from lack of resources/known strategies as well as learner and instructor readiness. Kirk (2007) further indicates that providing feedback on one's integrity could be threatening. In current study, both traditional classroom-based teaching pedagogy and hands-on community engagement were reviewed. To bridge a gap between academic teaching/learning and real world situations, the author proposed service learning as a means to teach cultural humility and empower students with confidence in serving clients from culturally/linguistically diverse backgrounds. To provide a class of 51 students with multicultural and multilingual community service experience, the author partnered with the Tzu-Chi Foundation (an international nonprofit organization). In this article, the results, strengths, and limitations of this service learning project are discussed.

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